Key result
Enabling and need factors, including being uninsured, having ≥3 psychiatric hospitalizations, lower GAF score, and homelessness, were significantly associated with increased risk of readmission.
Why the study?
What are the predictors of psychiatric readmission within 30 days, 90 days, and 1 year of discharge among patients with bipolar disorder?
Observational (n=2,443)
No
What are the predictors of psychiatric readmission within 30 days, 90 days, and 1 year of discharge among patients with bipolar disorder?
Enabling and need factors, such as being uninsured, multiple prior hospitalizations, and lower functioning scores, are strong predictors of psychiatric readmission in bipolar disorder patients at safety-net hospitals.
May inform readmission risk stratification in bipolar disorder at safety-net hospitals; leaves open whether targeting these factors reduces readmissions.
OBJECTIVE: Even with treatment, approximately one-third of patients with bipolar disorder relapse into depression or mania within 1 year. Unfavorable clinical outcomes for patients with bipolar disorder include increased rates of psychiatric hospitalization and functional impairment. However, only a few studies have examined predictors of psychiatric hospital readmission in a sample of patients with bipolar disorder. The purpose of this study was to examine predictors of psychiatric readmission within 30 days, 90 days and 1 year of discharge among patients with bipolar disorder using a conceptual model adapted from Andersen's Behavioral Model of Health Service Use. METHODS: In this retrospective study, univariate and multivariate logistic regression analyses were conducted in a sample of 2443 adult patients with bipolar disorder who were consecutively admitted to a public psychiatric hospital in the United States from 1 January to 31 December 2013. RESULTS: In the multivariate models, several enabling and need factors were significantly associated with an increased risk of readmission across all time periods examined, including being uninsured, having ⩾3 psychiatric hospitalizations and having a lower Global Assessment of Functioning score. Additional factors associated with psychiatric readmission within 30 and 90 days of discharge included patient homelessness. Patient race/ethnicity, bipolar disorder type or a current manic episode did not significantly predict readmission across all time periods examined; however, patients who were male were more likely to readmit within 1 year. The 30-day and 1-year multivariate models showed the best model fit. CONCLUSION: Our study found enabling and need factors to be the strongest predictors of psychiatric readmission, suggesting that the prevention of psychiatric readmission for patients with bipolar disorder at safety-net hospitals may be best achieved by developing and implementing innovative transitional care initiatives that address the issues of multiple psychiatric hospitalizations, housing instability, insurance coverage and functional impairment.
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Hamilton et al. (2015) conducted an observational in Bipolar disorder (n=2,443). Enabling and need factors (e.g., uninsured status, ≥3 prior hospitalizations, lower GAF score, homelessness) vs. Patients without these risk factors was evaluated on Psychiatric readmission within 30 days, 90 days and 1 year of discharge. Enabling and need factors, including being uninsured, having ≥3 psychiatric hospitalizations, lower GAF score, and homelessness, were significantly associated with increased risk of readmission.
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